Pseudoaneurysm diagnosed by endoscopic ultrasonography via color doppler flow mapping and contrast enhancement

Managing Femoral Artery Pseudoaneurysm Using Snare-Guided Through-and-Through Access With Perclose ProGlide

Iatrogenic femoral artery pseudoaneurysm (IFAP) is a common complication following endovascular procedures. Treatment options include manual compression, ultrasound-guided compression, thrombin injection, and surgical repair, each with its own limitations. Recent case reports have described successful IFAP treatment using the Perclose ProGlide/ProStyle (Abbott Vascular, Lake Bluff, USA) suture-mediated closure device by directly puncturing the pseudoaneurysm sac and advancing a guidewire into the native artery. Herein, we present a novel through-and-through wire technique using the same device for treating IFAP. The technique involves advancing a microcatheter into the pseudoaneurysm from the contralateral femoral artery, deploying a snare through it, and then puncturing through the center of the deployed snare to establish through-and-through wire access for Perclose deployment. We successfully treated a 60-year-old woman who developed a femoral artery pseudoaneurysm following angiography. Compared to previously reported direct puncture techniques using Perclose, this approach allows real-time angiographic confirmation of device deployment and may reduce radiation exposure to operators compared with direct puncture techniques. While further experience is needed to determine its optimal role in clinical practice, this technique may serve as an effective alternative in the endovascular treatment of IFAP.

A Pseudoaneurysm of Aberrant Right Subclavian Artery Caused by Esophageal Stent Placement Because of Esophageal Stricture After Endoscopic Submucosal Dissection

A 67-year-old man who received endoscopic submucosal dissection for an early squamous esophageal cancer was hospitalized for dysphagia. The mucosal defect was over three quarters of the circumference, and the distal edge of the resection scar formed the stenosis after 8 months. After experiencing conservative treatment, probe expansion, and esophageal stent placement, the symptom of deglutition disorder in the patient was improved, but persistent hemorrhage and progressive anemia occurred in the short term. An enhanced neck and chest computed tomography (CT) showed a contrast agent leaked from the aberrant right subclavian artery to the esophagus. A pseudoaneurysm of the aberrant right subclavian artery and subclavian artery-esophageal fistula were diagnosed by CT angiography. Although false aneurysms developing after iatrogenic injury and trauma have been reported, those caused by esophageal stent placement because of esophageal stricture after endoscopic submucosal dissection have not. When persistent hemorrhage and progressive anemia develop after esophageal stent placement, an enhanced CT should be performed to exclude the false aneurysm.

Percutaneous suture technique with ProGlide to manage vascular access pseudoaneurysm after percutaneous coronary intervention procedure: A case report

Iatrogenic femoral artery pseudoaneurysm is a common complication of the endovascular procedures. Manual compression and thrombin injection are the conventional techniques to occlude the pseudoaneurysms. However, there are still some failed cases that applied these treatment options. The aim of the study is to seek a potential and alternative method with ProGlide system to close the pseudoaneurysm. During April 2018 to February 2019, 2 patients with iatrogenic pseudoaneurysm of the superficial femoral were treated with the suture-base closure device--ProGlide. After punctured the pseudoaneurysm and placed a 6-F sheath, the guide wire was placed in the right femoral artery via the access of the pseudoaneurysm neck. Then the pseudoaneurysm neck was sutured by ProGlide to occlude the blood supply to the pseudoaneurysm. These 2 patients were cured with no complications and complaints, which revealed that percutaneous suture technique with ProGlide at the neck level of pseudoaneurysm provides a novel method for the management of vascular access pseudoaneurysm, especially in those with a wide and short neck.